Op-Ed: Want to Lower Drug Costs? Make Imports Legal

Every day, countless people across America order prescription drugs from pharmacies in other countries as they hunt for something increasingly elusive -- affordable medications.

But there's a problem. Under most circumstances, importing medicines is illegal.

And it is time to scrap this prohibition, unless Congress finds another way to drive down drug costs.

Consider this: 60% of Americans say lower drug costs should be a top priority, and a whopping 72% support the idea of importing medicines from Canada, according to a recent Kaiser Family Foundation poll. In fact, 8% of adults surveyed reported that they or someone in their household have already bought prescription drugs from outside the U.S.

Meanwhile, the cost of 20 widely used drugs is three times cheaper in Canadian than in New York pharmacies, according to PharmacyChecker.com, a website that vets overseas pharmacies and compares prices. And as drug makers regularly hike prices -- sometimes to sky-high levels -- or set steep price tags for the newest treatments, more American pocketbooks are pinched than ever before.

"The problem is getting worse," said Rep. Peter Welch, a Vermont Democrat who last week unsuccessfully attempted to stick an importation amendment onto a regulatory bill.

Yet from the time nearly two decades ago when seniors made headlines by taking buses to Canada to stock up, the pharmaceutical industry has stymied every attempt to allow Americans to import medicines. Drug makers have succeeded by exploiting fears over safety concerns. They've also lavished political contributions on members of Congress.

The latest example of pharma pushing back against importation came in the form of a report released this month by former FBI director Louis Freeh, who was once a Bristol-Myers Squibb board member and now runs a consulting firm. His sobering conclusion: Importation would increase the threat of counterfeit medicines into the U.S.

"The burden of enforcement will fall on American authorities, and the resources for this are really minimal," said Freeh, whose firm was commissioned by the Partnership for Safe Medicines, a nonprofit with ties to the pharmaceutical industry. "I think safety would go right off the boards."

His prediction comes shortly after four former FDA commissioners chimed in with their own dire warnings. In an open letter to Congress, they wrote that importation is "a complex and risky" idea that would harm consumers and compromise the existing safety system.

To be sure, there is reason to be cautious.

Counterfeit medicines have entered the U.S. supply chain before. In one widely publicized episode several years ago, a Canadian company supplied doctors with fake copies of the Avastin breast cancer treatment. And in 2003, a crime ring successfully peddled phony Lipitor pills to wholesalers, some of whom looked the other way.

But this doesn't mean that importation is impossible.

"We should be able to address the safety issue," said Dr. Aaron Kesselheim, an assistant professor of medicine at Harvard Medical School who has studied the topic. "To not have the conversation and instead say there's no way to import medicines safely is a cop-out."

Many people may not realize this, but the U.S. already imports 80% of all active pharmaceutical ingredients used to produce medicines -- and also imports 40% of prescription drugs, according to the FDA. And anyone who tracks FDA inspections knows that many overseas suppliers have racked up egregious safety violations.

To move the ball forward, Welch attempted to address concerns that the supply chain would be too porous, potentially allowing in phony drugs. He also borrowed elements from a bill introduced by Sen. Bernie Sanders that would create steps to allow both individuals and wholesalers to import drugs. The Sanders bill would also prevent drug makers from restricting supplies to Canada or charging higher prices to Canadian pharmacies to make ordering from that country less desirable.

There may be legitimate questions, though, such as whether Canadian pharmacies could fill prescriptions for U.S. citizens. And there are concerns the Canadian government might step in to curb sales over worries about shortages. Moreover, the bill would rely heavily on Canadian regulators to ensure safety.

"This would be quite a departure for the FDA," observed Tim Squire of the Fasken Martineau law firm in Toronto.

Consequently, the bill has gone nowhere fast.

But doing nothing to curb drug prices is not an option. Unfortunately, Congress is good at doing nothing. Meanwhile, Americans will buy drugs from overseas, and so lawmakers need to take this seriously.

After all, you don't need to take a bus anymore to buy lower-cost medicines from north of the border.

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